Transcript Atlantic Health Leadership Development Series
Health Reform and New Jersey
Sally Roslow 609-275-4224 [email protected]
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Agenda
Political Outlook
National Healthcare Reform
State Update Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
GOP Challenges
• • •
Unlikely to have two-thirds vote necessary to override presidential vetoes
•
Law responds to genuine needs Law saves government money…repealing provisions could be “spenders” Many provisions “connected”
National Healthcare Reform
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Key Items in Reform
32 million covered (expansion begins 2014)
923,000 New Jerseyans
300,000 Medicaid 600,000 Exchange
Insurance mandate (2014)
Large employers pay $2000/employee fee
Insurance market reforms
No lifetime caps Children up to age 26 Can’t deny coverage for pre-existing conditions Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Key Items in Reform
cont’d
Medicaid expansion – 133% of FPL Tax on Cadillac Plans (2018) Closes Medicare prescription drug “donut hole”
Geographic variation
$400 million carrot for low cost / high quality states
IOM study Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Key Items in Reform
cont’d
Readmissions – imposes penalties for “excess” readmissions (heart attack, heart failure & pneumonia)
$7.1 billion over 10 years (2013) Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Healthcare Reform 2010-2019
Cost Coverage How – $1 trillion/10 years – 32 million – Individual and employer mandates – Medicaid expansion – Insurance exchanges
NJ Specifics – 923,000 of 1.3 million uninsured covered – Hospitals will contribute $4.5 billion/ 10 years Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Strategic Directions
Movement away from fee-for-service toward integration
Emphasis on value versus volume
Emphasis on quality versus quantity Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
“The Secretary shall…”
“The Secretary Shall” Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Rethinking the Organization of Care Where is your place? What is realistic? What is achievable?
Accountable Care Organizations Post Acute Care (PAC) Episode Bundling Primary Care Physicians Specialty Care Physicians Outpatient Hospital Care and ASCs Acute Care Episode with PAC Bundling Inpatient Hospital Acute Care Acute Care Bundling Long Term Acute Hospital Care Inpatient Rehab Hospital Care Skilled Nursing Facility Care Home Health Care Medical Home
Source: The American Hospital Association (AHA)
Strategic Issues for Hospital / Healthcare Leaders
Reinvent ourselves as we continue to provide quality care, largely under old system (volume and procedures) even as we shift to P4P
Anticipate impact of reduced payments from Medicare
Get ready to jump to new way of doing business
But don’t jump too soon or too late Many advise acute care hospitals to plan to reduce costs to maintain profitability at Medicare rates Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Strategic Areas to Focus Upon
Enhance efforts to improve quality and patient safety (Focus on outcomes, care coordination, evidence based medicine & comparative effectiveness)
Reduce variation in care in your organization (then region, then state… county)
Increase clinical and operational efficiencies
Reduce avoidable readmissions Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Strategic Areas to Focus Upon
cont’d
Conduct community needs assessment (req’d for tax-exempt hospitals)
Assess/strengthen plan for HIT and EHR. Move to doctor/patient/hospital connectivity
Examine readiness for episodic payment, care redesign and ability to manage care across continuum
Foster better alignment with physicians Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Making Delivery System Reform a Success
Three Keys to Delivery System Reform
Quality Health IT Clinical Integration
NJHA Healthcare Reform Resource Center
http://www.njha.com/Reform Implementation schedule Grant opportunities Regulations News and updates Resources and links Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
FY12 State Budget
The state is projecting a $10.5 billion budget shortfall on an approximately $30 billion budget
Cuts and reductions in governmental spending are highly anticipated
DHSS looking at consolidating funding CMS approval of current budget plan still pending
Increased assessment moving forward Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Healthcare Reform : State Implementation
NJ Protect
High Risk Pool - Initiated August 2010
Administered by Horizon Blue Cross Blue Shield
Coverage to approximately 21,000 individuals
Insurance Exchange
Must be operational by Jan. 1, 2014
NJ DOBI recently awarded $1 million grant to review exchange creation
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Healthcare Reform : State Implementation
Insurance Reform
August 16, 2010, NJ receives $1 million grant to conduct premium reviews of health insurance companies
Medicaid Expansion
Beginning Jan. 1, 2014, Medicaid coverage will be expanded to 133% of the federal poverty level for non elderly individuals
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association Questions?